The Silver Lining
In the profession of neuropsychology we are witness to the challenges and strengths of both our patients and their families. Families come to us to find answers to their questions; questions about themselves, about their child or their parent, about how they fit within the larger world, and how they get from where they are now to where they want to be in the future.
The vast majority of the time we are able to offer clear direction to the patient and their family so they can take the next step to address the results of their evaluation; whether that's therapy, medication, support, or any number of other solutions or combination of solutions we provide with our diagnoses.
Unfortunately there are situations where we, and every neuropsychologist, struggles to find a solution for our patients. Probably the most frustrating result for us is when we test a child for a learning disability and their result falls just-above the limit for diagnosis of a learning disability. So the child shows significant impairments to the extent that they are doing very poorly in regular stream classes, but their impairments aren't significant enough for the child to meet the criteria of a Learning Disability and, therefore, they are ineligible to receive special education services through their school district. It's frustrating to know that these children are stuck in a no-man's-land where their family must solely bear the burden of providing services to help their child achieve success in school. But, we have seen over and over the strength and dedication of these parents and guardians to do whatever it takes to help their child through this adversity. Whether it's choosing to home-school, hiring tutors, or working closely with the child's current teachers to augment the learning day, these parents and guardians are tireless and they provide the silver lining in these seemingly no-win situations.
We assess individuals of all ages; from toddlers to the elderly. Alzheimer's assessments are particularly difficult from an emotional stand point. They are more difficult than diagnosing Autism or Mental Retardation in a child because with a child there are avenues for therapies to help them cope with their disability. There is promise. There is always the well spring of hope, even with such a difficult diagnosis. However with dementia, the diagnosis is usually simply a confirmation of what someone, or their care givers, have suspected. Dementia is such a cruel disease; robbing intelligent and self-reliant people of their capacity to live, act and think independently. It's never easy to give the diagnosis; even when the caregivers already suspect it.
But I have been lucky to witness, in spite of these horrible diseases, the beauty and love that the care givers have for their elderly loved ones, and the pure honesty of these afflicted patients. One of my favorite experiences was when I was performing Alzheimer's assessments on a married couple in their 70's; both the husband and wife had been previously diagnosed with Alzheimer's and my assessment was to determine the progression since the previous assessment a year earlier. I walked into the waiting room and was greeted by their daughter who introduced me to her parents; her dad was barely taller than me (and I'm 5' 2") with thinning grey hair and glasses, smiling blue eyes and a slightly round shape dressed in a dress shirt with bowtie, a red cardigan, khakis and white sneakers. He reminded me of my own grandpa; the kind of man that grandkids love to snuggle with, who always had a candy in his pocket to share, and who would secretly give you a cookie and whisper, with a wink, "Don't tell your mother." As I greeted him, he turned back to his wife and smiled, and she demurely smiled back. She was small and slender with her grey hair pulled back into a pony tail, with soft blue eyes and creases from a lifetime of smiling and laughing; the kind of wrinkles I'd be happy to attain.
We were barely in my office when the gentleman whispered to me, "I hope that pretty lady in the waiting room will still be there when we're done." It immediately occurred to me he was talking about his wife. He was flirting with her! I assured him that she will definitely be there because she had an appointment with me too, and he immediately smiled and said, "She's very pretty." My heart melted. After the assessment I walked him back to the waiting room where he immediately began, anew, his flirtations with his wife. Their daughter approached me with a knowing smile; "They do this all the time. Every day is like their first date" she told me. I then greeted the mother and began escorting her to my office and she whispered to me, in almost the exact same way as her husband, "That gentleman in the waiting room is quite handsome! Do you think he's available?" I suppressed a laugh and said, "I'm certain he is, and he mentioned how pretty you were." She beamed and said, "I hope he's still here when we're done, do you think it would be too forward to invite him for coffee?" I replied, "I'm sure he'd love that." My heart was bursting with how sweet and loving these two were. After the assessment was done they were reunited in the waiting room and, as their daughter mentioned, they immediately began flirting with each other.
The devastating effects of Alzheimer's on the afflicted and their families cannot be overstated. But on this day, this one day, the disease had stripped away from these two people all the years of anxiety and stress and struggle and had left their core selves: Just a boy and a girl discovering love for the very first time. We all remember that intense feeling from our first crush. And the beauty was that they got to live that wonderful feeling over and over again, every single day.
